The Trial Innovation Network Liaison Team: building a national clinical and translational community of practice

In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.

Barriers and facilitators to recruitment of underrepresented research participants: Perspectives of clinical research coordinators

Background

Insufficient recruitment of groups underrepresented in medical research threatens the generalizability of research findings and compounds inequity in research and medicine. In the present study, we examined barriers and facilitators to recruitment of underrepresented research participants from the perspective of clinical research coordinators (CRCs).

Methods

CRCs from one adult and one pediatric academic medical centers completed an online survey in April-May 2022. Survey topics included: participant language and translations, cultural competency training, incentives for research participation, study location, and participant research literacy. CRCs also reported their success in recruiting individuals from various backgrounds and completed an implicit bias measure.

Results

Surveys were completed by 220 CRCs. CRCs indicated that recruitment is improved by having translated study materials, providing incentives to compensate participants, and reducing the number of in-person study visits. Most CRCs had completed some form of cultural competency training, but most also felt that the training either had no effect or made them feel less confident in approaching prospective participants from backgrounds different than their own. In general, CRCs reported having greater success in recruiting prospective participants from groups that are not underrepresented in research. Results of the implicit bias measure did not indicate that bias was associated with intentions to approach a prospective participant.

Conclusions

CRCs identified several strategies to improve recruitment of underrepresented research participants, and CRC insights aligned with insights from research participants in previous work. Further research is needed to understand the impact of cultural competency training on recruitment of underrepresented research participants.

Mammography of the postsurgical breast

Breast biopsy results in many radiographic abnormalities, some of which may be mistaken for carcinoma. A retrospective review of 4,023 mammographic examinations was undertaken to determine the incidence and natural history of postbiopsy changes, in order to provide background information helpful in differentiating postsurgical scarring from breast cancer. The study comprised 863 patients who had undergone biopsy before mammography (1,049 breasts). Abnormalities attributed to prior biopsy were found in 474 breasts (45%). Skin changes (thickening and deformity), architectural distortion, and parenchymal scars (poorly defined masses often with spiculated margins) were observed much less frequently 3 years after biopsy than they were within the first 6 months, suggesting that considerable resolution can be expected with time. All abnormal mammographic findings were detected in patients radiographed within 6 months of biopsy, most within 1-2 months of biopsy. These observations may be helpful, in carefully selected cases, in establishing the benign (i.e., postsurgical) nature of radiographic abnormalities that might otherwise be confused with malignancy.

Intramammary scar tissue: a mimic of the mammographic appearance of carcinoma

Scar tissue within the breast parenchyma, when dense and located adjacent to fatty tissue, often appears as a poorly defined, spiculated mass on mammography. Intramammary scars may also appear as areas of architectural distortion or clustered microcalcification, sometimes associated with thickening or retraction of overlying skin. Because of the difficulty in differentiating such benign lesions from carcinoma, false-positive diagnoses of cancer occur. This article illustrates the radiographic spectrum of intramammary scars to familiarize the reader with this entity. Although several differential criteria have been described to help distinguish benign scarring from carcinoma, these features are not totally dependable, resulting in the need for biopsy in most cases and careful clinical and radiographic observation in others.

B-mode ultrasonography of prosthetic vascular grafts

The role of contact B-mode ultrasonography in demonstrating prosthetic vascular grafts was assessed in 24 patients (27 grafts). All grafts were well delineated. End-to-side bypass grafts could be separated from end-to-end replacement grafts by their characteristic appearance. Patent and occluded grafts could not be distinguished either in vivo or in vitro. However, B-mode ultrasonography was ideally suited to the detection of other complications of vascular prosthetic grafts: hematoma, infection, and false aneurysm formation.

Gallstones preventing ultrasonographic visualization of the gallbladder

Ultrasonography can be used to diagnose the presence of multiple gallstones, despite the fact that the gallbladder, per se, may not demonstrated. The finding of many echoes in the area occupied by the gallbladder that cast a large acoustical shadow is strongly suggestive of gallstones.

Malignant tumors of the testis: analysis of treatment results and sites and causes of failure

A total of 150 patients with germinal testicular neoplasms treated at the University of California, San Francisco, were reviewed. The 5-year actuarial survival rate was 95% for 57 patients with seminoma and 56% for 75 patients with carcinoma. Treatment modalities were compared with respect to sites and causes of failure and complications. The most common sites of failure in the carcinoma patients were lung, and supraclavicular or mediastinal lymph nodes. Scrotal orchiectomy, elevated gonadotropins, elements of choriocarcinoma, and bulky abdominal disease were all correlated with high treatment failure rate.

Xanthogranulomatous pyelonephritis in childhood

Urographic, arteriographic and B-mode echographic findings in a four-year-old girl with tumefactive xanthogranulomatous pyelonephritis are reported. Review of our case and those that preceded it illustrates that when a localized mass in a functioning kidney is encountered radiographically in a child, xanthogranulomatous pyelonephritis should be included in the preoperative differential diagnosis. Nephrectomy may then be avoided.